Living with achalasia like Seahawk Malcolm Smith

February 6, 2014 Leslie H. Price, MD

On February 3, 2014, Yahoo Sports published an article regarding this years’ Super Bowl MVP, Malcolm Smith, as not only achieving recognition for his Super Bowl performance, but also dealing with a rare swallowing disorder known as achalasia.
Achalasia is a rare disorder with a prevalence of 10 cases per 100,000 individuals.  Men and women are equally affected and it is usually diagnosed between the ages of 25 to 60 years.  The disease often comes on slowly and is gradually progressive with problems swallowing solids and liquids, and movement of undigested food particles back up into the mouth unintentionally (bland regurgitation).  Patients also often complain of a burning chest sensation. Other symptoms include hiccups, difficulties belching, and sometimes weight loss.

The condition can be seen with radiology studies including a barium esophagram that shows a dilated, or larger than normal, caliber of the esophagus with a narrowing or tightness at the lower esophageal sphincter. The lower esophageal sphincter is located at the end of the esophagus before it enters the stomach.  An upper endoscopy or camera study is often performed to evaluate the esophagus and stomach closely.  It is ultimately diagnosed with high-resolution esophageal manometry, which is a technique for evaluating esophageal motor dysfunction or movement disorders of the esophagus.

Once achalasia is diagnosed, there are different treatment options to consider based on your medical history, age, and preferences. These include surgery, dilation (which is a procedure to open up the lower esophageal sphincter), or botox injection to relax the muscle of the lower esophageal sphincter.

Malcolm Smith’s story opens a public conversation about the importance of identifying swallowing disorders. Often patients will have symptoms that are present for years prior to seeking medical attention. However, it is important to diagnose the condition earlier rather than later since early intervention may prevent worsening dilation of the esophagus.

If you are concerned that you may have a swallowing disorder, talk to your doctor and consider asking for a referral to the Swedish Digestive Health Network, or call 1-855-411-MYGI (6944).

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